Code STEMI: Twelve Months Following Initial “CODE STEMI” Experience—Registry

Introduction: Faster door to balloon (DTB) times are associated with improved survival in ST elevation myocardial infarction (STEMI). Key strategies in reducing DTB time are shortening the door to activation (DTA) time of the cardiac catheterisation laboratory (CCL) and earlier patient transfer to the CCL. Traditionally, the treating cardiologist performs CCL activation and patients are routinely transferred once the CCL staff call for the patient. We implemented a change in practice in February 2009 to ED activation of "Code STEMI" thereby decreasing activation and door to balloon times. We wanted to ensure the early good results were being reproduced. Aim: To study activation rates, the presence of false positives, and maintenance in DTB times, 12 months on from a very successful "Code STEMI" implementation. Methods: DTB and DTA times were prospectively recorded in all patients undergoing primary PCI between October 2009 and December 2010. This 14-month follow on data was reviewed and compared to the data from the original experience from February 2009 to October 2009. Results: The DTB and DTA times continue to improve (DTB: 77 minutes 2009 vs 69 minutes 2010). There have been transient increases in false positive CCL activations noted that have required ongoing emergency/cardiovascular medicine communication. Conclusion: Ongoing review and monitoring of ED activated STEMIs are required to ensure activation criteria are being adhered to, and to maintain door to balloon times and adherence to the activation protocol.